Managing noise through nudges: a mixed methods study on decision-hygiene in public management

Abstract

Nudging interventions can enhance expert decision-making in public management, improving resource use and equity. Using a parallel mixed-methods design, we experimentally tested 2,763 healthcare professionals’ prescribing decisions. Results show physicians are susceptible to systematic errors (i.e. bias) and exhibit variation in choices when presented with the same case (i.e. level noise), but their choices are influenced in the desired direction by guidelines, cost information, command-and-control mechanisms, reduction targets, and social comparisons. Nudges effectively reduce or redirect between-subjects variability. We also compare two noise measures: equality in distribution versus standard deviation. Semi-structured interviews with 36 healthcare managers explored real-world applications of educative and architectural nudges and root causes of noise.

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